Korean J Adult Nurs.  2019 Feb;31(1):68-77. 10.7475/kjan.2019.31.1.68.

Resilience as a Moderator and Mediator of the Relationship between Symptom Experience and Quality of Life in Hemodialysis Patients

• Cho YH
• Lee YM

• KMID: 2438762
• DOI: http://doi.org/10.7475/kjan.2019.31.1.68

Abstract

PURPOSE
The purpose of this study is to identify the moderating and mediating effects of resilience in the relationship between symptom experience and quality of life.
METHODS
Participants were recruited from one general hospital and one hospital specialized in hemodialysis located in Busan city. The participants included 105 patients diagnosed with chronic renal failure who had been receiving hemodialysis twice a week or more on a regular basis. Data collection was conducted from December 14, 2017, to January 15, 2018. Collected data were analyzed using the SPSS/WIN 24.0 program.
RESULTS
There were significant correlations between participants' symptom experience and resilience (r=−.36, p < .001), symptom experience and quality of life (r=−.50, p < .001), and resilience and quality of life (r=.67, p < .001), respectively. Resilience had a partial mediating effect (z=−3.48, p < .001) in the relationship between symptom experience and quality of life but did not have moderating effects.
CONCLUSION
To improve the quality of life among patients on hemodialysis, it is necessary to develop interventions that enhance resilience in addition to providing symptom relief.

MeSH Terms

Busan
Data Collection
Hospitals, General
Humans
Kidney Failure, Chronic
Negotiating
Quality of Life*
Renal Dialysis*
Resilience, Psychological

Reference

1. Denhaerynck K, Manhaeve D, Dobbels F, Garzoni D, Nolte C, De Geest S. Prevalence and consequences of nonadherence to hemodialysis regimens. American Journal of Critical Care. 2007; 16(3):222–35.

2. The Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul: ESRD Registry committee, Korean Society of Nephrology;2018. [cited 2018 December 29]. Available from:. http://www.ksn.or.kr/rang_board/list.html?code=sinchart.

3. Cha J, Yi M. Symptom clusters and quality of life in patients on hemodialysis. Journal of Korean Clinical Nursing Research. 2014; 20(1):123–33. https://doi.org/10.22650/JKCNR.2014.20.1.123.

4. Kim JY, Park SY, Lee MJ, Lee YL, Chang JE, Chung HJ, et al. A study on the correlation between perceived social support and the quality of life of hemodialysis patients. Journal of the Nursing Academic Association of Ewha Womans University. 2004; 38:19–41.

5. Danquah FVN, Zimmerman L, Diamond PM, Meininger J, Bergstrom N. Frequency, severity, and distress of dialysis-related symptoms reported by patients on hemodialysis. Nephrology Nursing Journal. 2010; 37(6):627–39.

6. Lee MH, Song MS, Yoo KM. Relationship among Powerless-ness. Self-Efficacy and Quality of Life in Hemodialysis Patients. The Korean Journal of Rehabilitation Nursing. 2002; 5(2):166–79.

7. Morsch CM, Goncalves LF, Barros E. Health-related quality of life among haemodialysis patients-relationship with clinical indicators, morbidity and mortality. Journal of Clinical Nursing. 2006; 15(4):498–504. https://doi.org/10.1111/j.1365-2702.2006.01349.x.

8. Kim J-Y, Kim B, Park K-S, Choi J-Y, Seo J-J, Park S-H, et al. Health-related quality of life with KDQOL-36 and its association with self-efficacy and treatment satisfaction in Korean dialysis patients. Quality of Life Research. 2013; 22(4):753–8. https://doi.org/10.1007/s11136-012-0203-x.

9. Kang MK, Kang SM, Kim SY. Moderating roles of public services in the quality of life of hemodialysis patients within the context of social support. The Journal of the Korea Contents Association. 2013; 13(11):277–87. https://doi.org/10.5392/JKCA.2013.13.11.277.

10. Li Y-N, Shapiro B, Kim JC, Zhang M, Porszasz J, Bross R, et al. Association between quality of life and anxiety, depression, physical activity and physical performance in maintenance hemodialysis patients. Chronic Diseases and Translational Medicine. 2016; 2(2):110–9. https://doi.org/10.1016/j.cdtm.2016.09.004.

11. Park KS. The effect of symptom experience, hope and resilience on quality of life in hemodialysis patients [master's thesis]. Gimhae: Inje University;2017. p. 38–40.

12. Sandler IN, Wolchik SA, Ayers TS. Resilience rather than recovery: a contextual framework on adaptation following be-reavement. Death Studies. 2007; 32(1):59–73. https://doi.org/10.1080/07481180701741343.

13. Ha BY, Jung EJ, Choi SY. Effects of resilience, post-traumatic stress disorder on the quality of life in patients with breast cancer. Korean Journal of Women Health Nursing. 2014; 20(1):83–91. https://doi.org/10.4069/kjwhn.2014.20.1.83.

14. Wu W-W, Tsai S-Y, Liang S-Y, Liu C-Y, Jou S-T, Berry DL. The mediating role of resilience on quality of life and cancer symptom distress in adolescent patients with cancer. Journal of Pediatric Oncology Nursing. 2015; 32(5):304–13.

15. Rainone N, Chiodi A, Lanzillo R, Magri V, Napolitano A, Morra VB, et al. Affective disorders and health-related quality of life (HRQoL) in adolescents and young adults with multiple sclerosis (MS): the moderating role of resilience. Quality of Life research. 2017; 26(3):727–36. https://doi.org/10.1007/s11136-016-1466-4.

16. Cho HM, Yoo EK. The factors influencing the resilience among hemodialysis patients. Korean Journal of Adult Nursing. 2014; 26(6):614–20. https://doi.org/10.7475/kjan.2014.26.6.614.

17. Cha J, Han D. Factors related to hope and relationships between hope, physical symptoms, depressive mood and quality of life in young adult and prime-aged patients with hemodialysis. The Korean Academy of Psychiatric and Mental Health Nursing. 2014; 23(4):250–8. https://doi.org/10.12934/jkpmhn.2014.23.4.250.

18. Shim OS. Effects of stress on health-related quality of life and moderating effect of self-esteem in patients on renal dialysis. Journal of Korean Gerontological Nursing. 2010; 12(2):95–107.

19. Weisbord SD, Fried LF, Arnold RM, Rotondi AJ, Fine MJ, Levenson DJ, et al. Development of a symptom assessment instrument for chronic hemodialysis patients: the dialysis symptom index. Journal of Pain and Symptom Management. 2004; 27(3):226–40. https://doi.org/10.1016/j.jpainsymman.2003.07.004.

20. Park JE. Symptom cluster and self-care activity in patients on hemodialysis [master's thesis]. Seoul: Korea University;2016. p. 93–96.

21. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety. 2003; 18(2):76–82. https://doi.org/10.1002/da.10113.

22. The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine. 1998; 28(3):551–8.

23. Min SK, Lee CI, Kim KI, Suh SY, Kim DK. Development of Korean version of WHO Quality of Life Scale Abbreviated Version (WHOQOL-BREF). Journal of Korean Neuropsychiatric Association. 2000; 39(3):571–9.

24. Baron RM, Kenny DA. The moderator-mediator variable dis-tinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986; 51(6):1173–82.

25. Kim E-K, Hwang S-K, Le Y-J. Dialysis adequacy, symptom experience, mood states and hope among patients receiving hemodialysis. Global Health and Nursing. 2018; 8(2):90–100.

26. Kwak SY, Byeon YS. Factors influencing resilience of patients with hematologic malignancy. Korean Journal of Adult Nursing. 2013; 25(1):95–104. https://doi.org/10.7475/kjan.2013.25.1.95.

27. Kim JI, Byeon YS. A study on the factors affecting resilience in patients with colon cancer. Asian Oncology Nursing. 2013; 13(4):256–64. https://doi.org/10.5388/aon.2013.13.4.256.

28. Ahn S, Park H. A study on sexual function, sexual stress, and quality of life in middle aged women patients with diabetes mellitus. Journal of Korean Academy of Fundamentals of Nursing. 2016; 23(4):393–401. https://doi.org/10.7739/jkafn.2016.23.4.393.

29. National Kidney Foundation. Patients [Internet]. New York: National Kidney Foundation;2017. [cited 2018 January 9]. Available from:. https://www.kidney.org/professionals/CNSW/aboutcnsw.

30. Choi E-H. Symptoms, mood and sleep disturbance in hemodialysis. The Korean Journal of Rehabilitation Nursing. 2010; 13(2):105–13.

31. Seo N-S, Kang S-J. Its relationship with symptoms index, self efficacy and family support in hemodialysis patients. Journal of the Korea Academia-Industrial cooperation Society. 2015; 16(10):6483–94. https://doi.org/10.5762/KAIS.2015.16.10.6483.

32. Kim AL. Stress, state anxiety, family support, patient provider relationship and sleep disturbance of hemodialysis patient. Journal of the Korean Data Analysis Society. 2014; 16(4):2161–75.

33. Liu YM, Chang HJ, Wang RH, Yang LK, Lu KC, Hou YC. Role of resilience and social support in alleviating depression in patients receiving maintenance hemodialysis. Therapeutics and Clinical Risk Management. 2018; 14:441–51. https://doi.org/10.2147/TCRM.S152273.

34. Kong K-R, Lee E-N. The mediating effects of resilience between symptom experience and depression in patients with chronic obstructive pulmonary disease. Korean Journal of Adult Nursing. 2015; 27(4):375–83. https://doi.org/10.7475/kjan.2015.27.4.375.